A/Prof. Rebecca Disler1, Dr Helen Hickson1, Miss Lena Ly1, Dr Amy Pascoe1, Dr Kristen Glenister2, Mrs Catherine Buchan1, Prof Julian Wright2,3, Dr Sivakumar Subramaniam3, Prof Doranne Donesky4, Prof Natasha Smallwood1,2, Prof Jennifer Philip5
1Monash University, Melbourne, Australia, 2Department of Rural Health, The University of Melbourne, Shepparton, Australia, 3Goulburn Valley Health, Shepparton, Australia, 4Department of Physiological Nursing, University of California San Francisco, San Francisco, USA, 5Department of Respiratory and Sleep Medicine, The Alfred Hospital, Melbourne, Australia, 6St Vincent's Hospital, Melbourne, Australia
Biography:
Assoc/Prof Disler is an Australian Research Council Discovery DECRA Fellow from Monash University. Through her research, she leads improvement in access to care and models of care for people living with advanced chronic disease, particularly in rural settings. Rebecca is funded by a prestigious ARC Fellowship to address end-stage chronic disease in rural Australia. As Fellow of the American and ANZ Thoracic Societies, Convenor of the Symptom Support and Palliative Care group for ANZ Thoracic Society, and as a Cochrane review author, her work has been included in several international and national guidelines, including NICE UK and global GOLD strategies.
Abstract:
Background: One in three Australian deaths are due to cardiopulmonary disease, with higher prevalence in rural populations.
Aim: This study aimed to understand current training in chronic disease and ongoing learning needs for specialist palliative care clinicians, and rural models of palliative care.
Methods: Mixed-methods study of specialist palliative care physicians and nurses, recruited through Australian palliative care organisations and snowballing strategy, Nov 2022 – Feb 2023. Online survey captured current skills and ongoing training needs regarding chronic conditions and respiratory therapies, via: 12 nominal; 1 short-response; and 3 free-text questions. Semi-structured follow-up interviews explored models of, and barriers to, chronic disease care in rural palliative care. Quantitative data were described, free-text analysed through content analysis, and interviews analysed thematically.
Results: Seventy-one palliative care clinicians responded (47 physicians and 23 nurses). Most were female (n= 56, 78.9%), 37.7% (n=26) were rurally based. Most physicians had >10yrs experience, and nurses 5-10 years. Completion of a chronic disease specific course was infrequent (21.3% physicians, 30.4% nurses), with generalised training in diseases of specific organs (ranging 60.9-83.0%) and age-related decline (43.5-59.6.5%) more frequent. While clinicians commonly managed varied respiratory therapies (23.9%-42.3%) and supported chronic breathlessness (n=36, 54.9%), few reported adequate training for these skills. Content analysis (n=64) similarly highlighted training gaps in respiratory specific skills, and the ongoing need for training in management of operational challenges such as those experienced during Covid-19. Interviews (n=7) extrapolated 3 themes in rural chronic disease, consistent with national and international data: 1) absence of specialised pathways for chronic disease; 2) unpredictable disease trajectories; and 3) patient misconceptions about palliative care.
Conclusions: Gaps are evident in chronic disease training for specialist palliative care physicians and nurses, including chronic breathlessness and respiratory therapies. Future research should target workforce training and palliative care referral pathways to support chronic disease populations.